J Dawn Abbott is the director of interventional cardiology and an associate professor of medicine in the department of medicine at the Warren Alpert Medical School of Brown University (Providence, USA). She talks to Cardiovascular News about her career in interventional cardiology, the importance of personalised medicine, and how the field has changed in light of COVID-19. Abbott also discusses her work as part of the Women in Innovations (WIN) committee at the Society for Cardiovascular Angiography & Interventions (SCAI) and its work to improve opportunities for women in interventional cardiology.
Why did you decide to become a doctor, and why did you choose to specialise in interventional cardiology?
My personal experiences with doctors as a child were very positive and I was interested in a career in the medical field before high school. By age 16, I took the Emergency Medicine Technician (EMT) course and was volunteering on the ambulance in my hometown. My family was always supportive and I was the first to attend college. At University of Chicago Pritzker School of Medicine, I was drawn to the operating room and doing research in vascular surgery. As a third year medical student I was placed on an inpatient cardiology rotation and at the end of the month the attending remarked that I would be a terrific interventional cardiologist. I did not know much about the field at that time, particularly that there were few women in the specialty, but the ability to treat patients in a minimally invasive way through an endovascular approach seemed novel and challenging. Interventional cardiology suited me and I have never looked back on that decision.
Who were the biggest influences on your early career?
When I was in medical school and training at Yale I was very focused on each rotation and research project, trying to gain knowledge and skills. At that point I was more influenced by the culture of the institutions than specific individuals. Faculty and role models were almost exclusively in academic medicine with careers in research or as educators in addition to some level of patient care. David O Williams, who I met in my first faculty position at Brown, was the biggest influence early in my interventional career. He acted as a mentor and sponsor, helping me with grant applications, introducing me to collaborators and colleagues, providing me opportunities to present at conferences, and recommending me for committees and editorial responsibilities. He was also a skilled cath lab operator, being one of the first in the country to perform percutaneous coronary intervention (PCI). I respected him and wanted my career to be similar. Being selected for the Emerging Leadership programme (ELM) and the Women in Innovations (WIN) committee through the Society for Cardiovascular Angiography & Interventions (SCAI) were also very influential. The mentors and peers I interacted with in these organisations were inspiring and remain important to me to this day.
What has been the most important development in interventional cardiology during your career?
As an interventional cardiology fellow, about 15% of the PCI cases were brachytherapy for bare metal stent restenosis. When we participated in the first drug-eluting stent (DES) trial and early reports of the effectiveness of these devices were emerging, I knew the landscape was changing. The eventual development of thinner and more biocompatible DESs has allowed performance of PCI in the most complex anatomy. Of course, most would say that structural interventions really pushed the limits of catheter-based therapies and have rivalled surgical approaches in remarkable ways.
What are your current research interests?
Since my involvement in the National Heart, Lung, and Blood Institute (NHLBI) Dynamic Registry of PCI, I’m always looking to harness the power of registry and administrative data to understand the landscape of interventional cardiology. The methods used to assess trends, outcomes, and subgroup associations can generate hypotheses and identify areas to further investigate. Contributing to randomised clinical trials is also a priority and I am currently a co-investigator on an NIH funded study comparing a liberal to restrictive transfusion strategy in patients with anaemia that suffer a myocardial infarction.
What do you feel has been your biggest contribution to interventional cardiology?
Biggest is an intimidating word. Being a patient advocate, educator, clinical researcher, and volunteering in cardiovascular societies have defined my contributions. One of the recognitions I am most proud of is being considered one of the Top Doctors in Rhode Island in Cardiovascular Medicine.
What are the key unanswered questions that future research should prioritise?
There needs to be more attention to research in personalised medicine and focusing treatment on individuals in addition to diseases.
What do you think the next breakthrough innovation in interventional cardiology will be?
There have been so many important innovations that need to be optimised such as bioresorbable scaffolds and percutaneous mitral valve therapies. Another trend I think we will see is the increasing use of artificial intelligence, such as automated pressure derived indices and co-registration algorithms. This information should be routinely available to patients undergoing PCI.
You have been involved in the SCAI WIN-CHIP Fellowship; how has this helped to further the representation of women in the field of interventional cardiology?
This tremendous opportunity ensures women can obtain advanced interventional training. It takes down barriers by providing mentorship and procedural training with flexibility in programme location. The skills and professional relationships that are developed during this year jumpstart a career. SCAI WIN is thankful to our industry partners for providing unrestricted funding and to the programmes that sponsor the awardees.
What impact has the COVID-19 pandemic had on your practice?
The most difficult aspects were the inability to perform elective PCI when the hospital was near capacity and deciding the best way to care for patients with COVID-19 and cardiovascular manifestations. We developed protocols and cath lab staff trained on proper use of personal protective equipment (PPE). Patients were scared and many were avoiding the hospital, so our ST-elevation myocardial infarction (STEMI) volume was highly variable and many patients were presenting critically ill. Thankfully, telemedicine provided a way to care for and communicate with patients.
What are the implications of COVID-19 for the management of patients with structural heart disease?
Since structural heart procedures utilise a team approach, the stress on hospital resources and personnel during a pandemic limit the ability to maintain procedural volumes. Therefore, it is necessary to prioritise patients that need the procedure on an urgent or emergent basis. Unfortunately, there can be unanticipated consequences of postponing elective procedures in these patients. Catheter-based procedures have a shorter length of stay compared with surgery, and should be preferred in patients with both options during COVID-19 surges.
What advice would you give to someone who was starting out in cardiovascular medicine?
There are so many quotes about “paths” for a reason. Find your own interests and your definition of success. Cardiovascular medicine is a phenomenal career choice for any person because of all the subspecialty options. Women should not be discouraged; interventional cardiology is a rewarding career and we need more diversity in the field. Lastly, do not postpone your personal life—take care of yourself and enjoy time with your family and friends.
What are your hobbies and interests outside of medicine?
One of my bad habits is that I am not good at relaxing. To disconnect, I find travel and sports with my husband and daughter are the best activities. In the winter we ski and snowshoe. The summers in Rhode Island are spent on the water, sailing and boating the coast and islands. I find international travel and learning about ancient civilisations fascinating. Prior to COVID-19, we travelled to Egypt, Peru, Turkey, and several European cities. I am looking forward to finding new adventures in the future.
- Director, Interventional Cardiology Fellowship, Brown University, Providence, USA
- Associate Chief, Faculty Development and Academic Advancement, Cardiovascular Division, Brown University, Providence, USA
- Staff Physician, Cardiology/ Interventional Cardiology, Rhode Island & Miriam Hospitals, Providence, USA
- Fellow of the Society of Coronary Angiography and Interventions (SCAI)
- Fellow of the American College of Cardiology (ACC)
- American Heart Association (AHA)
- Medical School:University of Chicago, Pritzker School of Medicine, Chicago, USA
- Residency: Yale New Haven Medical Center, New Haven, USA
- Fellowship: Yale New Haven Medical Center, New Haven, USA